Eating and food are important to people and a relationship between nutrition, health and wellbeing has been well established. Work is a source of social contact and prestige, as well as providing economic opportunities to pursue healthy choices, while work cultures, schedules, and patterns have a major impact on our eating behaviours. My PhD study explores nutrition knowledge and behaviour amongst construction workers in the UK. This is of particular importance, given that approximately 7% of the UK workforce are employed in the construction industry, and also the high level of work-related ill health in this group. Additionally, in construction, long working hours, high pressure working environments, remote site locations and long commutes make healthy food choices challenging.
This project is the first UK study exploring the effectiveness of a workplace intervention on nutrition knowledge and behaviour amongst employees in the construction industry. For my PhD, which is supervised by Dr Margaret Coffey and Dr Anna Robins, I am designing, developing and evaluating a participatory nutrition intervention, with the purpose of improving the health and wellbeing of construction workers. The first (exploratory) phase of the project, informed the next phases, including the questionnaire development, and intervention design. Focus groups with construction workers and managers took place on three different sites exploring their nutritional practices and eating habits, as well as to identify barriers and facilitators to healthy nutritional choices in the workplace. I investigated perceptions of current health strategies and ways to facilitate healthy nutritional choices amongst construction workers.
These are some of the things that construction workers told me during my research, which illustrate some of the challenges of achieving a healthy diet for workers in this industry:
“They’ll pick up the fizzy drink or an energy drink. So you smash an energy drink, I’ve seen it on other sites, up the river, people don’t even have lunch sometimes, they’ll just have an energy drink just to get through the day, which, yes, that’s suits me but it’s just full of sugar, it’s absolutely packed”
“I’ll maybe go to the Grub’s Up van that comes around and get rice and chicken covered with cheese. It tastes good, but I know it’s slowly killing me”
“By the time I get home I really can’t be bothered cooking”
“If we’re in B&Bs, which several of us have been at various times over this project, there’s nowhere to store food, no fridges or microwaves”
When I started the Public Health Masters programme, I knew that I was going to do my dissertation on a sexual health related issue. Working in sexual health for several years I knew there were a few issues that needed research. One such topic that concerned me was the low HIV screening uptake from women had taken priority. The issue seemed small because it had never been discussed during meetings or conferences that I had been to or watched, until I found a document that confirmed that women feel marginalised in HIV related care. The report was named ‘Invisible no longer’ and was authored by the Sophia Forum and Terrance Higgins Trust (2018). It helped me to brainstorm: (1) the aim of my dissertation; (2) how I wanted to collect the data; and (3) who I wanted to interview. During this time, I felt I won a quarter of the battle as I gradually searched for relevant details to eventually discuss with my supervisor.
A few months before any dissertation-related work was required, the lecturers organised a visit from Salford City Council public health to identify: (1) who has a project that may be helpful to them (2) provide a project or idea to those who did not have one. I liked the fact the lecturers were getting the class involved in work that could be used externally, as well as a chance to work with an organisation.
I remember being excited to start my project as I watched my idea develop over the weeks and months before even writing the first line of my literature review! My aim was to identify the barriers and facilitators of women testing for HIV outside of maternity services in the UK, since evidence demonstrated women were not screening for HIV as much as men, nor were they being offered the test as frequently. Witnessing the lack of HIV testing for women first hand, I had a feeling it could be a result of a mixture of things such as the lack of HIV health promotion for women or women having a low perception of HIV risk as well as stigma. I really wanted to collect evidence to understand why women had such a low testing uptake, but to get there I knew I needed to speak to women who were HIV positive and I knew that could be a challenge since women are rarely approached for HIV related research.
Understanding what I wanted to achieve was one thing but putting a project together was another! This is why a supervisor is very important. Your supervisor will help you to structure your project to maximise data collection as well as ideas and providing you with the necessary support you need. Don’t forget the library can help you with using journal databases so you can expand your search terms! I found that service incredibly helpful as I tried to focus on research from western countries.
Writing my dissertation started during COVID-19. Working on the frontline I now attempted to balance university work, home life (what was left of it) and work. It was incredibly hard and my headspace was all over the place. My supervisor and the university were incredibly supportive during this time and I am very thankful. As the first wave passed it was time to collect data and I ended up hitting a few hurdles for a number of reasons, but I had my supervisor to support me during this process and I was keen to understand the complexities of women testing for HIV kept me going.
Finishing the project I could not be more proud of myself, especially completing it in such an uncertain time! I never felt unsupported. Some of my classmates became friends and we supported each other. One thing I was ecstatic about is sending my report to the Sophia Forum and receiving feedback! That is rewarding in itself! In the end my project did not continue with Salford Council as COVID-19 erupted, but It did not stop me from sending my report to organisations who I felt who be interested to read my findings. I gained further feedback from them also, which ended up being submitted to an All Party Parliamentary Group HIV testing inquiry! Mega happy! Coming to the end of my blogging time, I want to say If you already have a project in mind in the early days of the course (1) brain dump as much things as possible (OneNote helped me to organise my brain chaos) and (2) gradually search for relevant things, at this stage you don’t have to worry about narrowing it down; just have an understanding of the topic, find out if it has been researched already and think about what your project could do differently (if it has previously been researched). Later on in the course you can discuss your project with your supervisor, where you can begin to narrow your ideas if necessary. Some things you may keep and others you may not, but what you have may form a framework for your dissertation, which can be half of the battle—well maybe a quarter of the battle! If you do not have a project I would recommend to find something that will keep your interest! There may be times when you do not want to write and it may sound cliché but my passion kept me going!
Tuesday 8th October saw our newly bonded MSc
Public Health students set forth for the wilds of Derbyshire, on a field trip
as part of the Evidence Based Public Health Module. The aim of this field trip
was to give us all an understanding of real-world public health in action, to
show the development of public health through the ages, and to spend some time
together as a group to get to know each other better.
I had never heard of this village and indeed began the trip
by repeatedly pronouncing its name wrongly (think Eeeeeem—to rhyme with steam—rather
than the two syllables you brain will probably go to initially). A quick Google
search identified it as ‘The Plague Village’, which sounded intriguing but I
avoided reading much more as I didn’t want to have too many preconceptions.
On the way to the village we stopped at the glorious Chatsworth House to see how the other half lived! I had always wanted to visit here and it did not disappoint, a perfectly grand National Trust property set in the most beautiful gardens and wider landscape, just walking round I got a real feel for how incredible it must have been to live here and the impact an estate like would have on the wider communities in terms of providing work/opportunities to sell/buy produce.
We continued on to Eyam to find a more realistic
representation of how the majority of people would have lived in the 1600’s
(whilst all secretly still wishing we lived at Chatsworth!). As a group we
toured the village with tutors pointing out areas of interest. The village
suffered terribly when the plague hit and as a community took positive action
(potentially to their detriment) to avoid onward passage of the disease.
We saw the homes of those who had passed away and the innovative methods of intervention that the villagers put into place to avoid passing the disease on.
We visited the church and graveyard where a beautiful window has been installed commemorating the sacrifices made by the people of Eyam, and also displays showing some interesting facts and anecdotal stories of individuals…needless to say we were impressed with Margaret Blackwell’s accidental cure!
The afternoon of this first day was spent doing group work in the classrooms at the hostel, this involved research and working together to create presentations telling the story of the plague and exploring the implications of the villager’s choices. It was a great opportunity to work together in a relaxed environment, fortified by many cups of tea and the beautiful views from the classroom windows!
After dinner in the hostel it was onto the evening activity, which consisted of a rousing game of Pandemic! I had never played this boardgame before and after we were all initially confused by the YouTube video of instructions that never seemed to end, we decided to get on and have a go. Turns out we weren’t too bad and were soon working together to save the world (Disclaimer: we probably need another couple of practice games before we could actually save the world!).
Day 2 saw us back in the classroom working in groups to
look at the modern-day issues around Plague, we were really surprised to find
out that there are still significant pockets of it about, and to look at
government and health agencies approach to tackling this. It was great way of
looking at global inequalities and their impact on population health.
After lunch there was just time for look round Eyam’s museum which has so many interesting displays and resources on plague in the village. It was a useful way of consolidating what we had learned and seeing some effective visual representations of the spread and reach of disease, including really personal stories.
The trip was a great success and we found it so useful to see public health in action through history. It was a great opportunity to spend some quality time together and definitely helped to bond us as a group, which will hopefully stand us in good stead for our next assignment where group work is vital.
Foetal alcohol spectrum disorder (FASD) is the range of conditions that can be caused by prenatal alcohol exposure (PAE). People with FASD can have a wide range of physical and mental difficulties, especially with planning, attention, impulsivity, coordination, social communication, emotional arousal, and memory. These difficulties can impact daily living, school, work, social relationships, and long-term health and wellbeing. In the UK, it is estimated that at least 3%, and possibly up to 17% of the population would qualify for a diagnosis on the foetal alcohol spectrum, although the majority will never be diagnosed. FASD has been known about for several decades but does not yet receive appropriate attention in schools and universities, meaning that many doctors, teachers, social workers and other professionals are not trained to spot the signs of FASD. This can leave children and adults with FASD struggling with the academic and social demands of everyday life without the support they need. Unsupported, people with FASD are more likely to be excluded from school, lose their job, struggle with addictions, and be convicted of a crime. FASD is thought to be especially common in looked after and adopted children and care leavers. Many of these individuals also have histories of traumatic experiences such as abuse or neglect in early childhood, which are also known to lead to developmental difficulties similar to those seen in FASD.
I came to the University of Salford in 2015 to conduct research on the combined effects of PAE and childhood trauma. The project was offered as a funded PhD in partnership with the National FASD clinic in Surrey. I had just completed my degree in psychology and already had some experience in alcohol research, but like many others I had never heard of FASD. The first stage of the project was a thorough review of the published literature on FASD and trauma. I was surprised to see that very little research had been published on the combined effects of both exposures, only five studies in fact, but there did seem to be an interesting pattern of results emerging. Taken together, the studies suggested that children with both PAE and trauma were functionally similar to children with just PAE but tended to have more difficulties than children with just trauma. This suggests that, where children have both exposures, PAE is more likely to be the primary driving force behind those children’s difficulties. The published studies had tended to focus on speech, language and communication, but other areas of functioning still needed to be addressed. Therefore, during the next stage of the project I conducted studies into brain functioning, intelligence, working memory (the ability to hold and manipulate information in the short-term), inhibitory control (the ability to stop oneself from performing an action that feels natural), empathy (an understanding of the perspective and emotional state of other people) and behavioural difficulties in children with PAE, about half of whom also had a history of trauma. I was interested to see whether the children with both exposures had similar or more severe difficulties than the children with just PAE.
Since FASD is largely a hidden condition, I suspected that recruitment of participants would be challenging. Most of my participants were recruited via social media, especially online FASD support groups, which had been set up by families affected by FASD to provide mutual support and information. In order to access as many participants as possible, I used an anonymous online questionnaire to ask parents and carers about their children’s PAE, trauma, empathy and behavioural problems. The strategy worked, and 245 parents or carers completed the questionnaire, many more than I had expected. As well as UK respondents, many were from the United States and Canada, which reflected the populations of the online support groups. To make as much use as possible out of the participants, I invited the UK respondents to bring their children in for some further assessments. Many of the families lived outside of the Greater Manchester area where we are based, and I only had funding to offer £10 for travel expenses, but an amazing 25 families affected by FASD came into the university, some travelling hundreds of miles at their own expense to get here. In the lab, I used a brain-imaging technology called functional near infra-red spectroscopy (fnirs) to look at brain activity, a standard IQ test to measure intelligence, and puzzles to assess working memory and inhibitory control. Finally, I also conducted interviews with 12 parents and caregivers, to explore their experiences of raising a child or children with FASD.
The results of the questionnaire and lab studies between
them supported the findings of the literature review. Children with both PAE
and trauma had similar brain activity, intelligence, empathy, inhibitory
control, and working memory to children with just PAE. In terms of behavioural
difficulties, children with both exposures had a slight tendency to have more
severe conduct problems than children with just PAE, but their emotional
functioning was similar. The studies also showed that children with PAE have
high levels of childhood trauma, severe behavioural difficulties and poor
empathy compared to typically developing children, although intelligence,
working memory and inhibitory control were within the average range. In the interviews,
parents’ experiences were fairly consistent, and there was little difference
between the experiences of parents of children with and without trauma. I asked
parents about their children’s behavioural difficulties, which I expected would
be described as stress inducing. This was the case, although parents also
described many positive experiences. However, even though I didn’t specifically
ask, every family described some level of stress caused by dealing with service
providers. Doctors and other healthcare workers often didn’t understand and
were unable or reluctant to diagnose FASD. Adoption agencies and social workers
were accused of playing down the impact of PAE in order to secure a placement,
then leaving families to deal with FASD with no specific support or training.
Parents and children were offered services designed for trauma and attachment
issues, even when children had no history of trauma. There was a widespread
lack of understanding and lack of services designed to deal with FASD, and this
seemed to be the most stressful part of their experiences.
Taken together, the results of the published studies, questionnaires, lab studies and interviews show that children with both PAE and a history of trauma appear to function similarly to children with just PAE and tend to have more severe difficulties than children with just trauma. Therefore, the difficulties seen in children with both of these exposures seem to be primarily caused by PAE rather than childhood trauma. Based on these findings, my recommendation would be that children seen in care, school, or in a medical setting, who have both PAE and a history of trauma, should be thought of more as a child with FASD than a child with a history of trauma. The trauma absolutely should not be overlooked, as it will definitely have had an impact, but in terms of interventions, therapies and strategies, those designed specifically for FASD may be more effective than those designed for trauma. These conclusions have led to a new project; my colleagues and I are currently developing a parent training programme designed specifically for FASD issues, something which is currently missing in the UK. The full thesis is available in the University of Salford institutional repository.
My PhD journey started when I joined the University of
Salford in 2015. Before this I had completed a BSc in Sport & Exercise
Science and an MSc in Clinical Exercise Physiology, followed by several years
working as a researcher in the health technology industry. Along the way I had
also completed qualifications in gym instruction and exercise referral
instruction. Therefore, the planets aligned well when an opportunity arose to
complete a PhD about exercise referral schemes, combining research experience
with personal interests.
Exercise referral schemes are one of the most common
approaches to increasing physical activity levels in people with long term
conditions, providing access to individualised exercise programmes and support
from qualified exercise professionals. There are hundreds of these schemes
operating across the UK, illustrating their popularity as a method of physical
activity promotion. However, the evidence base underpinning the effectiveness
of these schemes to-date has been poor. The aim of my PhD was to contribute to
this evidence base, by evaluating Tameside’s “Live Active” exercise referral
Fortunately, the scope of my PhD was quite broad, meaning
that I could develop and practice a wide range of research skills. The majority
of my data was quantitative, some of which was secondary data collected by the
scheme, and some of which I collected using accelerometers. With so many different types of data, I found myself
conducting several types of statistical analyses, from simple to complex
statistical tests, several of which I was trying for the first time!
Fortunately, I was able to take a break from all of this quantitative data, by
conducting a qualitative study. This was the most enjoyable chapter for me, and
in the end, turned out to be a very important chapter, revealing findings that
were central to my final conclusions.
Dr Faye Prior with supervisor Dr Margaret Coffey at graduation
In March 2019 my PhD journey came to an end, when I successfully defended my thesis at the viva. Following this, I was fortunate enough to be offered a position as a senior research associate at the Equality and Human Rights Commission. Health inequalities were an important consideration in my thesis, and have always been an area of interest and motivation, so this is a fantastic opportunity to explore equality and human rights more broadly. I have no doubt that I would not be in this position, if it were not for the research and transferable skills that I developed throughout my PhD, with the help of my fantastic supervisors, Dr Margaret Coffey, Dr Anna Robins, and Prof Penny Cook. By the end of your PhD, you will have developed more skills than you may realise, some of which will be quite broad and highly valuable, and you must not forget this when planning your next steps after the PhD!
Of course, for myself, and many other students, the PhD
journey provided an opportunity to experience and practice more than just the
intricate details of research study. Throughout the three years I attended
several conferences, both home and abroad, sharing the findings of my research
through posters and oral presentations. I also met several other researchers at
these conferences, with the same research interests as myself. It has been
great to stay in touch with these people, to discuss our research, provide each
other with feedback, and some have been kind enough to invite me to collaborate
on their work in the future. It was also great to complete this PhD with a
partner organisation, Live Active, where I got to develop my stakeholder
engagement skills, and attempt to influence practice with my research findings!
Teams4U is a charity that brings volunteers from the UK to make a difference in children’s lives in countries including Bosnia, Belarus, Romania, Sierra Leone and Uganda. This was my third visit with Teams4U to the Mukongoro district of Kumi Region, Uganda, to participate in their work with schools to improve public health. In recent months Teams4U’s attention has focused on reducing the days missed from school due to sickness and diarrhoea. An intervention to improve hygiene and sanitation has been developed.
Teams4U volunteer with school children
There is no water supply or electricity supply to the public schools, although there is typically a hand pump installed at the perimeter of the school grounds, which is shared resource for the school and the local public. There are usually three or four pit latrines for the children to use. The latrines often have no doors for privacy and used by around 1000 children, making the smell and flies unbearable. There is no source of water nearby for hand washing.
Open pit latrine
When children are at home, there are also often no hand washing facilities. Each day water is carried from the nearest hand pump and stored in water containers for cooking and washing, but many homesteads lack a drum with a tap for easy hand washing. Some families are not aware of the importance of hand washing to prevent disease.
A typical homestead
A ‘Tippy tap’ is a contraption that is simple to make with a small water container, rope and wooden supports. A child can easily tip the drum to let the water out by using the foot operated lever. They are suitable for use at a homestead. Some schools have been using them, although a single tippy tap is inadequate for the typical school which has over 1000 children.
Demonstrating the tippy tap
With support from the Welsh Government, Teams4U have begun to install simple hand washing facilities, comprising a large tank with two taps and bars of soap on string. These tanks can store sufficient hand washing water for a whole school. They still require filling by hand, but schools arrange teams of children to carry water from the pump to the tank as part of their daily chores. The tanks can be drained during holidays to allow them to be cleaned. Some schools fill their tanks with soapy water to get over the problem of soap bars going missing.
Hand washing using a new tank supplied and installed by Teams4U
The Teams4U installation also includes ‘toilet flappers’ fitted to each of the long drop latrines and signage about hand washing on the walls. The toilet flappers are simple devices that remain closed to seal off the odours and stop flies from entering the long drop. They function similarly to the flaps in the portable toilets that are used in festivals in the UK.
Toilet flapper to fit to a pit latrine
Volunteers get involved
The whole school also watched as Teams4U volunteers acted out a hand washing story about a Ugandan boy who does not wash his hands and becomes ill. In the story he then learns about hand washing and when to wash hands. The story features the family’s naughty goat, who causes great hilarity amongst the children when he runs amok. The use of the tippy tap is demonstrated, and the boy learns how and when to wash his hands properly. He learns to wash his hands after handling animals, after using the toilet and before meals. He finds in the future he is no longer ill.
Volunteers performing the play for the whole school
As in previous trips, the Teams4U volunteers visit a school each day for seven days. The morning activity is a physical activity intervention where all 1000 or so children take part in simple team games. In the afternoon, there are sessions for the older children that focus on puberty, development and respect for women. These have been the subjects of my previous blogs. There is also an opportunity for volunteers to play with the children. The challenge is to think of activities that overcome the language barrier and can be done with hundreds of children at a time! Successful activities include simple face painting, balloons and bubbles.
Teams4U volunteer face painting to entertain the school children
Click here to see a film of a volunteer entertaining the children with bubbles
The interventions with the children are supported by an education programme for the key church leaders, health care workers and senior women teachers. This is supported by funding from the Department for International Development (DFID). The training aims to provide a legacy for the ongoing education of the children in hygiene and disease prevention, dignity and respect, puberty, menstruation and sexual health.
Volunteers supporting the training of the teachers
How do we know it works?
The onus is on the charity sector to deliver an intervention that has a lasting impact. At schools we visited, there is evidence of previous well-meaning interventions that have had no impact. I asked why the schools needed Teams4U’s water drums when some had evidence of large water storage drums. I was told that the drums had been designed to collect rain water, but no one had ever installed the guttering to harvest the water. Boxes containing computers sit unopened in schools that have never had an electricity supply.
Volunteer in the classroom
In addition to the work to educate local leaders on how to sustain the benefits of the interventions, Teams4U will be collating data on school attendance in the coming weeks in order to determine whether the hygiene interventions have had an impact on absence due to diarrhoea. The aim will be to provide the intervention to all 150 primary/junior schools in the Mukongoro district. The charity has already demonstrated that its puberty and development sessions (‘Develop with Dignity’) are effective: knowledge of menstruation increased after the education sessions, and fewer girls miss school because of their periods.
Girls receiving washable sanitary ware as part of the Teams4U intervention
You can join in and help run the sports, ‘Develop with Dignity’ and sanitation programmes. Read more about volunteering opportunities on the Teams4U website. If you come as part of the University of Salford’s BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme during a heavily subsidised 10 day trip (the students pay £200 towards the cost of the trip).
A powerful experience for the volunteers
It is difficult to describe the pure pleasure that these children get from a little attention from the visitors. The impact on the volunteers is also profound as we experience the simple joy that children get from a hand shake or a stream of bubbles. It is also humbling to think how we take our children’s education for granted. In Kumi, there are no staff to clean the school. The sweeping of the classrooms, the fetching of the water and the cleaning of the toilets is all done by the children. Some of the forward thinking schools grow their own vegetables, and the children also tend to these. In several of the schools we are greeted with songs of welcome. The children also sing songs that describe how seriously they take their learning in order to better their lives. We found this truly humbling.
Children playing team ball games as part of the Teams4U intervention
With its numerous and diverse cultures, Winston Churchill wrote “Uganda is truly the Pearl of Africa” and went on to say “The Kingdom of Uganda is a fairy tale. The scenery is different, the climate is different and most of all, the people are different from anything elsewhere to be seen in the whole range of Africa….what message I bring back…concentrate on Uganda”. Over one hundred years later this is still true, and Uganda, relatively untouched by tourism, retains a taste of Authentic Africa.
Children at a primary school in Kumi
The University of Salford has been working with charity Teams4U for over eight years. Recently, the University’s partnership with Teams4U has been developed to allow students to gain hands-on experience of delivering a public health intervention programme in rural Uganda, learning how to break down cultural barriers and to communicate with the people they serve in order to make the programme a success. Students on our BSc Public Health and Health Promotion course have the opportunity to take a subsidised ten day trip to Uganda (the student pays £200 towards the cost).
The Teams4U Uganda programme is the brainchild of honorary Salford graduate Dr Dave Cooke, who wondered if physical activity could help primary school children to achieve better results at school. Since it began, the programme has evolved and changed to tackle some of the underlying issues that lock communities in a cycle of poverty.
Small changes make a big difference
The experience of handing a football to a child that has never touched a ball is something that is difficult to describe. Before the programme began, children in rural primary schools in the Kumi district of Uganda didn’t have PE lessons; with class sizes at over 100 children per teacher, finding an activity that they could all take part in was difficult. To make matters worse, the budget for most schools is just £1.50 per child for the whole year, meaning they can’t afford basic sports equipment like footballs. Often the schools aren’t funded at all – the money just ‘disappears’.
Playing the team games with Teams4U
The concept of the programme is simple, but the impact on the children is profound – headteachers have even said they felt inspired to change the way they teach as a result. However, this is where students can get involved in vital research, as many questions still need answering: does the experience of the teachers of the programme change their attitudes to physical activity? Does the donation of balls for football, netball and other activities have an impact on physical activity and sports in the schools?
Breaking the cycle of poverty
The programme also revealed other barriers to education that children in the community face. While both girls and boys are often kept off school to help out at home or work in the fields, girls in particular are not always encouraged to attend school. To add to this, we found that a big problem keeping girls from school was the lack of feminine hygiene products and limited access to water, meaning that they were missing up to a quarter of their schooling.
Keen to break the cycle of poverty where children drop out of school, girls have babies very young and have large families that they can’t support, the team set up two separate programmes to tackle these issues. The first, ‘Develop with Dignity’, provides washable pads for girls to use, meaning they now feel comfortable going to school on their period. Secondly, we organised educational sessions with parents, children and community leaders to discuss the importance of staying in school.
Girls receiving washable menstrual pads and underwear
Again, research is needed to understand exactly how these interventions work: does the intervention increase school attendance, for girls in particular? Are parents and the community more aware of the importance of education?
Join a trip to Uganda
You can join in and help run the sports and Develop with Dignity programmes. If you come as part of the BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme.
Our volunteers often find that while they go to Uganda with the intention of serving, they end up gaining more than they give: the experience of sharing time with children who get so much joy from the simple gift of your time and attention.
Find out more
Watch this video about the University of Salford’s public health and health promotion opportunities in Uganda
To find out more about the other public health and health promotion work that the University of Salford and Teams4U have carried out in Uganda, go to our related blog posts
Realistic workloads, supportive managers, fairness, and a bit of recognition for good work: are things like this too much to ask for employees? I’ve always been interested in work psychology, even before I knew it was possible to study it; after all, who wouldn’t be interested in making work better and less ‘stressful’? Despite recommendations from the National Institute for Health and Care Excellence that preventative interventions (strategies that target potentially stressful working conditions rather than employees’ ability to cope with them) should be prioritised, there is relatively little research of this type. Many years later, and having just completed my PhD looking at how employers might improve work for employees, and I’m probably a bit more realistic about how challenging that can be!
Who wouldn’t be interested in making work better and less ‘stressful’?
Can we make work better?
I was initially surprised when I started my research that the evidence for methods of improving work for employees and supporting their psychological health and well-being was rather mixed; some studies reported reasonable results, but many seemed to suggest they didn’t do any good at all. I soon found that this is in part because preventative approaches are usually very complex and involve lots of people and decisions, as well as relying on effective implementation. On top of that, there are likely to be many contextual and practical factors that can influence the process: unexpected events, organisational changes, limited resources, and even cynical employees, have the potential to derail even the most careful plans. So my initial focus on whether or not preventative approaches were effective quickly shifted to look at why even the most well-intentioned efforts can lead to disappointing results. My research aimed to add to our understanding of the factors that can derail them and learn lessons that can help with future efforts.
It’s certainly not all bad news, because there are things that employers can do to improve things, they just need to be aware of some of the pitfalls and get the planning and implementation right. For example, ensuring that employees have a say in identifying what aspects of the workplace should be prioritised, rather than senior managers deciding what’s best for them. Then there are seemingly obvious things – that are often forgotten – which can make a huge difference: communication, and follow-up. If you’re going to start a project to improve your workplace, it is vital to keep employees up to date on plans and progress, and that any promises are followed-up – fail to do that and employees might see yet another ‘well-being initiative’ introduced with great fanfare before it silently disappears under layers of new priorities. Is it any wonder employees might be cynical at times? There’s no one-size-fits-all solution, it’s incredibly complex, but thankfully the evidence suggests there are things that can be done.
Research in the ‘real world’
It can also be challenging to conduct research in organisations – although well worth doing – because, let’s face it, they are not there for the benefit of researchers. They naturally have their own priorities. For example, in my research, the organisation I worked with were supportive of my work and very keen to take action to improve things for their employees. However, because they were severely hampered by substantial cuts to their budget during my PhD project it meant large-scale restructuring was required, making it very difficult for them to fulfil all their original plans. As a researcher this was hugely frustrating, particularly as I had to complete my work within a set timescale, but it was obvious the organisation was being stretched and doing their best under very difficult circumstances. As a result, things didn’t happen when they were supposed to, or didn’t happen at all in some cases; welcome to the ‘real’ world of research! However, it taught me so much and it is probably a better piece of work because of some of these challenges, to be honest. There were also some positive outcomes (and plenty of lessons) for the organisation to use as they continue with their work to support employee well-being. And, as I graduated at The Lowry on the 18th July 2017, and having progressed to a lecturing post at Staffordshire University, I was able to look back with so much pride and wonder how on earth I got there!
The organisation was very keen to take action to improve things for their employees
Why the Lindsey Dugdill award is so special
The graduation was made all the more special by receiving the Professor Lindsey Dugdill award for my PhD thesis. Knowing how much Lindsey meant to her many friends at Salford, it’s quite hard to adequately express how much more this award means as a result. I was fortunate to meet Lindsey during my PhD, but I’d like to finish with an experience that took place several years previously when I submitted a proposal for a different PhD to the university. I had lots and lots of questions, and I was advised to contact Lindsey as the proposal was in her field. She was incredibly generous with her time and advice – spending her own time talking through my ideas and giving feedback. It is worth emphasising that this is despite Lindsey not being involved in the project, and had never even met me before – I was just a potential student with an interest in Lindsey’s field of expertise (or one of them!). It would be a better story if my application had been successful but circumstances at the university meant the funding was unavailable – Lindsey still got in touch with some encouragement. I cannot tell you how much I appreciated the time and trouble she took to help someone she didn’t even know, and I was delighted to be able to tell her in person when I actually joined the University a couple of years ago. Having met Lindsey, and having worked alongside so many of her close friends in Public Health and Psychology, I know this sort of support and encouragement was not a one off, which says it all really. A lovely person.
John Hudson receives his award from Dean of Health Sciences Kay Hack
The Teams4U motto is ‘real people making a real difference’, and one of the aims of the programme is to give the volunteers a life-changing experience. Some of the volunteers already knew each other and have done this trip before; others, like me, are new. It is amazing how quickly everyone has bonded and started to work as a real team. See my previous post for more information about the interventions. The games that we play with the children during the morning continue to be enormous fun, both for the volunteers and the children. The ‘Develop with dignity’ element has been refined and developed as we go along. The team members that deliver this element include a doctor, a nurse, a teacher as well as me. The final team member is a social worker from the local area. Fortuitously between us we have a combination of relevant skills, knowledge and experience.
Training the teachers
On day three, our usual format of our day was to be extended–after the main school programme, we went to a different school where we delivered a training session to all the senior female Primary 6 teachers in the district. The Head of Education in the district is a big supporter of the programme, and has strongly encouraged the teachers to come and facilitated their journey to the school where the training is to take place. P6 children are the target of the intervention–they can range in age from 12 up to 17 (because those who do not pass their exams do not move up to the next class). Whilst this was going on, other Team4U members did games, stories and face painting with the school children.
In the classroom with the teachers
For the train the trainer session we decided to give an overview of our aims and then present the same material as we present to the children to the teachers, so that they could see exactly how we delivered the intervention. It seemed to go well and was enjoyable from my perspective. At the end we asked the teachers for their views and feedback. We had a long discussion about the other contexts of the child’s life, and how for some children there is a lack of encouragement to go to school. Some are given no money to buy the necessary equipment, many have no food for the middle of the day. Teachers commented that some children were spending the time away from school, with neither the school nor the parents knowing where they are. This potentially puts girls in situations where they are at risk of rape. Teachers often saw their school girls alone after dark–again this is risky. The teachers felt that we needed an intervention for parents, a suggestion that we agreed to take back for consideration. We had a long discussion about whether the intervention was aimed at the right age, and while there was a feeling that some children at that age were innocent (and it was tempting to ask why they needed to know about sex and condoms), there was general acceptance that children of this age can and do get pregnant. We heard a shocking story of a 9 year old girl who had given birth recently.
On the way home we stopped and visited one of the little mud hut settlements in a very rural area. A father showed us around. He allowed us to see into each hut: the smallest was where there was a simple fireplace made of stones on the floor. The cook pot rests upon stones, and the smoke is chokingly thick. Three children were in one of the other huts and the father had his own hut. His wife and baby slept in a different hut.
The Games in the morning were great–the smile and excitement on the girls’ faces when they had a ball in their hands was just a picture, and it is so hard to put into words the satisfaction that we get from doing this. It seems to be reciprocated! The headmaster of today’s school made a special effort to tell us how important this visit was for him and the school, and a senior teacher told us that they will be adopting the games to play with the children every Monday from now on. I loved the pink uniforms in this school!
In this school many children received a school lunch, for which the parents have to make a modest payment. We learned that in some schools parents do not pay for lunches, and nor do they send food from home. School days are from 8am until 5pm in Uganda, which is a long time to go without food.
Other Team activities proceded as usual including the HIV counselling and testing. We have tested hundreds of people this week, both school children and their parents, and it is really good to be able to report that we have found very few people with HIV. About 7% of adults are estimated to be living with HIV in Uganda. Substantial progress has been made with testing and treating HIV, so that between the years of 2005 and 2013 the number of Aids-related deaths dropped by 19%.
Taking a small drop of blood for HIV testing
In the afternoon were were honoured with a visit from Vaughan Gethin (Cabinet Secretary for Health, Wellbeing and Sport, Welsh Government) and Jon Townley (from Wales for Africa). They were able to see Teams4U at their best, with an action-packed afternoon of HIV/AIDS & TB testing, Reproductive & Sexual Health Education, our Develop with Dignity programme; and of course, the smiles of hundreds of children having enormous fun with our enthusiastic volunteers!
L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O’Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)
I have been given the amazing opportunity to take part in some practical public health interventions in rural Uganda, with Teams4U, an organisation with many years’ experience of work with poverty. My aim is to get some insight so that I can plan trips in the future for University of Salford’s public health students.
Our journey here from Kampala had taken us 5 hours, during which we had glimpsed some of the poverty that is a reality of everyday life in rural Uganda: the roads were dirt tracks; people were pumping and carrying their water; children were dressed in rags; homes were shacks with little in the way of a decent roof.
Basic living conditions
Day one of the field-work happens to be Sunday. On Saturday night, the leader of our team of volunteers discovered that we were expected to be at a local Church for the 7am service. Thus, at 5.45am we were up, ready to set off at 6.30am. We learned that no practical intervention in the community can happen around here without the involvement of the church–it is the hub of the community, and it serves as a means to spread practical messages to the local people. The priest will be working with us all week in the various schools that we will be visiting. The church service lasted 2 hours, during which we had to get up at the front and introduce ourselves to a few hundred people. It was through the church that the community had been told about our visit, and invited to one of the local schools for a day of fun and activities.
Going to church
By 10am we were at the school. Being a Sunday, we were uncertain of how many people would turn up. In a very well organised operation we started to play team games with the children. There were hundreds. We did the games with batches of 8 children (for each of the 14 team members). We did this 3 times–first with some smaller boys (aged 5 to 12), then with girls (9-14) and then with some older boys (10-16). The games all involved running up and down, sometimes with a ball. They varied in each set, depending on age and gender; for example, games were more complicated for the older ones, and we had been warned that girls often did not own underwear, so we did not do any games involving somersaults. We were on the field without a break for nearly two hours, in the heat: absolutely exhausting but really good fun.
The games served as a draw to the local community, and while the fun was going on, adults were being tested for HIV, and if needed, able to obtain antiviral drugs straight away. We now also had the opportunity to do some basic health interventions with the children, after the games were over.
‘Develop with dignity’ intervention
Sanitation is very poor at this school. There is no water and open pit latrines. Once the girls have started their monthly menstrual periods, the lack of facilities, and lack of any means to manage their periods causes them to leave school for a few days each month. Girls typically manage their period using rags to absorb the blood. Fear of soiling clothing and embarrassment keep them away from school, causing them to miss up to quarter of their education. The aim of our intervention was to explain some basic facts about puberty, sex and management of menstruation. The highlight of the intervention is when we supply the girls with their own pack of re-usable, washable ‘Afripads’, and knickers to hold the pads in place. We also had a sack of donated bras, which the girls were absolutely delighted with!
The girls were very pleased with their washable pads and new knickers
As we left the school, children squabbled over our empty water bottles, which appeared to be a much sought after prize, reminding us how much we have and how much we take for granted. When we saw small groups of children we were able hand out little toys and gifts.